Flashcards in Ch. 12: Disorders of the Liver and Biliary Tract Deck (80):
name the two blood supplies of the liver
portal vein & hepatic artery
T/F: cirrhosis is reversible
portal vein goes ( ) liver
what makes up a portal triad?
1) bile duct
2) hepatic artery
3) portal vein
produced in the spleen (and liver) from hemoglobin breakdown, conjugated to glucuronide in the liver
increased uncongugated bilirubin
increased conjugated bilirungin suggest
decreased albumin suggest
increased PT and PTT (decreased coagluation factors) suggest
what are the four clinical sydromes of liver disease?
1) jaundice and cholestasis
3) portal HTN
4) hepatic failure
what is jaundice?
unconjugated bili (hemolysis)
conjugated or unconjugated bili (ex. viral hepatitis, cirrhosis, drugs)
conjugated bili (ex. obstruction by gallstones or cancer)
accumulation of bile in the liver by intraheptaic or extraepatic flow obstruction or defective hepatocyte bile secretion
what is cirrhosis?
cirrhosis is ( )% ETOH and viral hepatitis; ( )% cryptogenic
cirrhosis results in...
what is the only therapy for cirrhosis?
what is portal hypertension?
obstruction to portal blood flow
prehaptic portal hypertension
portal vein thrombosis, scarring, tumor
hepatic portal hypertension
cirrhosis (most common!)
posthepatic portal hypertension
right CHF, hepatic vein thrombosis
signs of portal hypertension
varicies and splenomegaly
portosystemic shunts; rectal, esophageal, caput medusae (umbilical vein)
CPC, may also have hypersplenism
what is hepatic failure?
loss of 80-90% of functional capacity of liver
most common cause of heaptic failure
hepatic failure leads to... (which does what?)
hepatic encephalopathy (increased ammonia and other toxins)
hepatic failure may develop what?
hapatorenal and hepatopulmonary syndromes (both have unknown etologies)
what percentage of hepatic failure is fatal?
in ACUTE cases of hepatic failure, half are due to ( ) in the US; remaining cases are due to ( )
-other drugs, autoimmune hepatitis or viral hepatitis
what are the 3 hepatitis clinicopathologic syndromes?
1) acute viral hepatitin
2) carrier state
3) chronic viral hepatitis
is there a thing as chronic hep A virus?
viral hepatitis: causes epidemic hepatitis
hepatitis A virus (HAV)
viral hepatitis: has infected 1/3 of the world population (2 bill), 350 mill have chronic infection
hep B (HBV)
viral hepatitis: usually (50-70%) progresses to chronic liver disease
hep C (HCV)
HBV: what percent is subclinical infection? how many can recover completely?
HBV: what percentage symptomatic acute hepatitis? how many can recover?
Rx for HCV...how much is this?
interferon and/or Solvadi;
$1,000/tab for 12 or 24 weeks)
viral hepatitis: infects only those with HBV
HDV: how type usually recovers?
coinfection (at the same time as HBV)
HDV: which type has most go on to chronic hepatitis
superinfection (after previous HBV)
viral hepatitis: most common form of epidemic hepatitis in India
viral hepatitis: similar to HAVE (transmitted by food/water, mild, no chronic or carrier state)
viral infection: exceptionally dangerous to pregnant women (20% fatality)
non-viral inflammatory liver disease: types of abscesses
2) amebic: entamoeba histolytica
abscess: more common in immunodeficient pts, high mortality
abscesses: countries with poor sanitation practices
amebic: entamoeba histolytic
chronic progressive hepaitis
autoimmune hepatitis: what percent female?
80% (>50% have other autoimmune diseases)
autoimmune hepatitis: most have ( ) muscle or ( ) antibodies
-anti-mitochondrial (these are more common in PBC)
how many of cases of fulminant liver failure are due to ACETAMINOPHEN?
half of the cases!
which toxic liver injury are dose-related?
which toxic liver injuries are NOT dose-related?
other drugs, anesthetic gase
what is a leading cause of liver disease?
metabolic liver disease: very common, metabolic syndrome (obesity, hyperlipidemia, htn and insulin resistance)
non-alcoholic fatty liver disease (NASH)
NAH may progress to...
metabolic liver disease: autosomal recessive; increased iron in liver, pancreas, heart, skin, joint (M:F ratio?)
hemochromatosis (10:1)-- 1/200 people
metabolic liver disease: disorder of copper metabolism (rare, autosomal recessive, increased copper in liver, brain)
metabolic liver disease:causes liver disease and emphysema
hereditary alpha-1 antitrypsin deficiency
prolonged biliary obstruction causes ( )
secondary biliary cirrhosis
what is the most common cause of biliary cirrhosis?
gallstones (then pancreatic cancer)
circulatory disorders: inhibits intrahepatic flow
circulatory disorders: secondary to CHF
chronic passive congestion
circulatory disorders: obstruction of the main hepatic vein
tumors of liver: most common tumor in liver
tumors of liver: oral contraceptives
tumors of liver: malignant tumor, CHILDREN
tumors of liver: risk increased with cirrhosis, chronic HBV and HCV
tumors of liver: increased serum AFP levels
tumors of liver: risk increased with HCV, sclerosing cholangitis
tumors of liver: cholangiocarcinoma survival rate
15% 2 year survival
cholelithiasis vs. choledocholihiasis
choledocholithiasis= stones in common bile duct
gallstones: cholesterol stones= ( )%
gallstones: risk factors for cholesterol stones
female, obesity, older
gallstones: pigement stones ( )%
gallstones: pigment stone risk factors
gallstones may lead to ( )
cholecystitis (acute and chronic)